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Wisconsin BadgerCare Reform Approval Period: October 29, 2024 through December 31, 2029 Page 30 g. Demonstration Year Definition. The Demonstration Years (DYs) will be defined as follows:

h. Budget Neutrality Monitoring Tool. The state must provide CMS with quarterly budget neutrality status updates, including established baseline and member months data, using the Budget Neutrality Monitoring Tool provided through the performance metrics database and analytics (PMDA) system. The tool incorporates the “Schedule C Report” for comparing the demonstration’s actual expenditures to the budget neutrality expenditure limits described in section 11. CMS will provide technical assistance, upon request. i. Claiming Period. The state will report all claims for expenditures subject to the budget neutrality agreement (including any cost settlements) within two years after the calendar quarter in which the state made the expenditures. All claims for services during the demonstration period (including any cost settlements) must be made within two years after the conclusion or termination of the demonstration. During the latter two-year period, the state will continue to identify separately net expenditures related to dates of service during the operation of the demonstration on the CMS-64 waiver forms in order to properly account for these expenditures in determining budget neutrality. j. Future Adjustments to Budget Neutrality. CMS reserves the right to adjust the budget neutrality expenditure limit: i. To be consistent with enforcement of laws and policy statements, including regulations and guidance, regarding impermissible provider payments, health care related taxes, or other payments. CMS reserves the right to make adjustments to the budget neutrality limit if any health care related tax that was in effect during the base year, or provider-related donation that occurred during the base year, is determined by CMS to be in violation of the provider donation and health care related tax provisions of section 1903(w) of the Act. Adjustments to annual budget targets will reflect the phase out of impermissible provider payments by law or regulation, where applicable. ii. To the extent that a change in federal law, regulation, or policy requires either a reduction or an increase in FFP for expenditures made under this demonstration. In this circumstance, the state must adopt, subject to CMS approval, a modified budget neutrality agreement as necessary to comply with such change. The modified agreement will be effective upon the implementation of the change. The trend rates for the budget neutrality agreement are not subject to change under this STC. The state agrees that if mandated changes in the federal law require state legislation, the changes shall October 29, 2024 through December 31, 2025 Demonstration Year 12 (DY12) January 1, 2026 through December 31, 2026 Demonstration Year 13 (DY13) January 1, 2027 through December 31, 2027 Demonstration Year 14 (DY14) January 1, 2028 through December 31, 2028 Demonstration Year 15 (DY15) January 1, 2029 through December 31, 2029 Demonstration Year 16 (DY16)